Sharpening Blunt Instruments

If you have been a regular reader of our articles, you know that we emphasize on the need for deep differential diagnosis. But the why the need for this deep thinking may not be so obvious. By and large the physiotherapy techniques are blunts instruments. They take much time to sharpen, experience that any physiotherapist sorely needs to get better at their profession. When the instrument is blunt, its impact is diffused, losing its impact and efficacy.

The Tyranny of Named Conditions

People like to know what they are dealing with. That’s our nature. We are uncomfortable when things are vague and unclear. Labels make everyone feel so much better even though what is behind the label itself may still be unclear. But that’s how we delude ourselves.

Take for example, when we have a bad cold and the doctor is unsure what of bacterial infection we are suffering from, he may just prescribe a wide-spectrum antibiotic that too weak (as not build up unnecessary resistance) or something that is too strong (anyone who has had stomach diarrhoea after too strong antibiotics would know).

The point here is that once we have this label, “it is just a cold” on hand, we think we know what the solution should be (kill the bacteria) and how to deliver it (antibiotics). But there are many conditions that may similar cold symptoms and even it if just a “cold”, we still need to know the precise type to better deal with it.

Unlike drugs which works by way of chemical interactions can be very precise, a lot of physiotherapy techniques are blunt. They work around a general area and can be very difficult to isolate.

Experience and Precision

A common refrain when discussing about experience goes something like, “Does he have 5 years of experience or 5 times of a years’ of experience?”. Anyone in almost any profession can ascertain that when hiring two different persons which the exact same years of experience can have very different level of expertise and effectiveness.

Clinical Reasoning – The millstone to physiotherapy techniques

The millstone that we need to sharpen these skills and techniques is clinical reasoning (or what we just call ‘thinking’). The differential diagnosis is what comes from reasoning and narrowing down the choice of technique; the mirror up to which we review our results.

Back and forth, like sharpening a knife against a millstone -with precise and intentional strokes. Only then do we get sharp and effective physiotherapy treatments.

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